Prevalence: Dependence doesn't discriminate

Opioid dependence is more common than many people think. Every year, thousands of people become dependent on prescription opioid pain medication after their medical need for pain relief has passed. Others become dependent from the recreational use of opioids, such as heroin.

No one is immune to opioid dependence. It affects men and women of all ages, races, ethnic groups, and educational levels. According to the 2005 National Survey on Drug Use and Health (NSDUH):

4.7 million people aged 12 and older were misusing pain relievers.

32.7 million people aged 12 and over had misused pain relievers in their lifetime.

Approximately 3.5 million people used heroin in 2005.

Prescription drug abuse killed more than 8,500 Americans in 2005.

The DEA reports that “opioid
painkillers now cause more overdose
deaths than cocaine and heroin
combined.”

What are opioids?

Opioids are drugs that have the same effect on the body as opium. Some opioids are made directly from opium (for example, morphine, codeine, and heroin). Other opioids are manufactured to be chemically similar to opium (for example, the pain medications oxycodone, hydrocodone, and fentanyl, with brand names such as OxyContin®, Vicodin®, Percocet®, and Actiq®).

For people in pain, opioids can be effective medicines for pain relief. For some, however, opioid dependence can be an unintended side effect of prescribed pain treatment.

How opioids work.

When opioids enter the bloodstream, they attach to opioid receptors (called mu receptors) in the brain, stimulate the release of dopamine, and produce pleasurable feelings. After repeated use, some people can experience withdrawal symptoms and cravings—and can have a strong psychological desire to repeat the experience.
So two things are going on here: One, withdrawal is so severe your loved one seeks out more drug. And two, cravings for the pleasurable feelings of euphoria induced by taking the drug, drives repeated use.

Nerve synapse in the brain where opioid receptors are located.

Dopamine is released and pleasurable feelings are produced.

As the opioid leaves the receptors, pleasurable feelings subside and possible cravings and withdrawal symptoms begin.

Why opioid dependence is a medical condition

Frequent and persistent use of opioids can cause brain cells to change the way they work. The brain can be "reset" to think the drug is necessary for survival. In other words, the brain of a person dependent on opioids can cause them to feel as though they cannot live without this drug—and eventually may cause them to adopt compulsive drug-seeking behavior.

Researchers have discovered that opioids cause long-term changes in the brain. In this sense, opioid dependence is a long-term disease similar to high blood pressure or diabetes. The good news is that opioid dependence can be treated effectively with drug therapy combined with counseling.

How opioids affect behavior.

The need to satisfy cravings or avoid withdrawal can be so intense that even people who want to stop taking opioids find this difficult. Consequently, they may find themselves doing things they wouldn't ordinarily do in order to obtain more of the drug they crave. For this reason, even though opioid dependence is a medical condition and not a moral failing, it can drive behavior.

How tolerance can lead to dependence.

When a person uses opioids, the brain gradually gets used to the drug and becomes less sensitive to it. As a result, the person needs more of the drug to achieve the same level of pleasurable feelings. This is how tolerance develops. With longer use or higher doses, the brain adjusts to the increased levels of opioids, and then requires those increased levels to feel satisfied or "normal" to avoid withdrawal. This is how tolerance can lead to dependence.

Physical dependence is typically associated with tolerance and withdrawal. Psychological dependence involves continued drug use despite harm. Psychological dependence can reach the point where people have uncontrollable cravings for the drug—and are willing to take significant risks to obtain it, regardless of the negative consequences to themselves, their families, their jobs, or their community.

Why some people are more likely to become dependent

The pleasurable feelings—as well as the unpleasant withdrawal symptoms—increase the likelihood that opioid use will be repeated. Most people who take these powerfully reinforcing drugs don't become dependent on them. Although the specific causes vary from person to person, certain factors, such as the opioid of choice, a family history of drug or alcohol dependence, genetic predisposition, underlying emotional issues, peer pressure, and the environment, can increase the chances of becoming dependent.

Understanding the stigma of opioid dependence

More and more, opioid dependence is being accepted as a long-term medical condition, like high blood pressure or diabetes.

Yet unlike these other conditions, opioid dependence carries a powerful stigma. For example: Imagine you're interviewing for a new job. You wouldn't think twice before asking whether the company's health plan covers the cost of insulin to treat your diabetes. But would you be as quick to ask about coverage of costs related to your opioid dependence?

This stigma is rooted in the long-held belief that drug dependence is a moral failure. Only within the last 20 years have researchers realized that drug dependence is a medical condition caused by changes in the brain.
Today, opioid dependence in the United States is growing at a fast rate. Sadly, the stigma associated with opioid treatment deters many people from seeking help.

Removing the stigma of opioid dependence is critical to helping people get proper care. A key part of achieving this goal is wider recognition that opioid dependence is a medical condition—not a moral failing. It's not about being a good or a bad person, it's about embracing treatment, including both medication and counseling, and going forward from there.